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October 15, 2020

LCD and Policy Article Revisions Summary for October 15, 2020

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Refractive Lenses, Surgical Dressings, and Urological Supplies. Please review the entire LCDs and related PAs for complete information.

Refractive Lenses

LCD

Refractive Lenses LCDExternal Website

Revision Effective Date: 10/01/2020

HCPCS CODES:

  • Added: HCPCS Code V2524 to Group 3 codes (effective for DOS on or after October 1, 2020)

10/15/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to add CMS HCPCS coding determinations.

PA

Refractive Lenses PAExternal Website

Revision Effective Date: 10/01/2020

CODING GUIDELINES:

  • Added: Guideline information for HCPCS code V2524

10/15/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Surgical Dressings

PA

Surgical Dressings PAExternal Website

Revision Effective Date: 01/01/2020

QUALIFYING DRESSING REQUIREMENTS:

  • Revised: Indication that eligible products "include both" to "are defined as"
  • Revised: Eligible product information, to include definitions of primary and secondary dressings

CODING GUIDELINES:

  • Added: Coding guidelines for Alginate or Other Fiber Gelling Dressings (A6196, A6197, A6198)
  • Revised: Clarified wound fillers as primary dressings
  • Revised: Clarified wound covers as primary or secondary dressings
  • Added: Clarification regarding sizing related to adhesive borders

10/15/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Urological Supplies

LCD

Urological Supplies LCDExternal Website

Revision Effective Date: 10/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Removed: HCPCS A4335 from inFlow device reference due to new HCPCS codes as of 10/01/2020

HCPCS CODES:

  • Added: K1010, K1011 and K1012 (effective DOS on or after 10/01/2020)

10/15/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to add CMS HCPCS coding determinations.

PA

Urological Supplies PAExternal Website

Revision Effective Date: 10/01/2020

MODIFIERS:

  • Removed: inFlow A4335 code from directions

CODING GUIDELINES:

  • Revised: inFlow HCPCS billing direction, HCPCS A4335 for DOS 07/26/2020 through 9/30/2020 and HCPCS K1010, K1011 and/or K1012 for DOS on or after 10/01/2020
  • Added: Billing direction for K1010, K1011 and K1012

10/15/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination

Note: The information contained in this article is only a summary of revisions to the LCDs and PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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